Recognition of Delirium Features in Clinical Practice: Data from the “Delirium Day 2015” National Survey

Mossello, Enrico; Tesi, Francesca; Santo, Simona Gabriella Di; Mazzone, Andrea; Torrini, M.; Cherubini, Antonio; Bo, Mario; Musicco, Massimo; Bianchetti, Angelo; Ferrari, Alberto; Ferrara, Nicola; Trabucchi, Marco; Morandi, Alessandro; Bellelli, Giuseppe

doi:10.1111/jgs.15211

Cited by 20 publications

(15 citation statements)

References 30 publications

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“…Moreover, the true impact of delirium in terms of PAF could be underestimated, since our variable is based on participants self-report. Indeed, it is known that delirium is frequently under-recognized in clinical practice [28], with low agreement on diagnosis even among delirium experts [29]. The tight and bidirectional relationship between delirium and dementia is widely reported, while the pathophysiological mechanism underlying this interplay is still poorly understood [5].…”

Section: Discussionmentioning

confidence: 99%

Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study

et al. 2020

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Background: Preventing dementia onset is one of the global public health priorities: around 35% of dementia cases could be attributable to modifiable risk factors. These estimates relied on secondary data and did not consider the concurrent effect of non-modifiable factors and death. Here, we aimed to estimate the potential reduction of dementia incidence due to modifiable risk factors elimination, controlling for non-modifiable risk factors and for the competing risk of death. Methods: Participants from the InveCe.Ab population-based prospective cohort (Abbiategrasso, Italy) without a baseline dementia diagnosis and attending at least one follow-up visit were included (N = 1100). Participants underwent multidimensional assessment at baseline and after 2, 4, and 8 years, from November 2009 to January 2019. Modifiable risk factors were low education, obesity, hypertension, diabetes, depression, smoking, physical inactivity, hearing loss, loneliness, heart disease, stroke, head injury, and delirium. Non-modifiable risk factors were age, sex, and APOE ε4 genotype. The primary endpoint was dementia diagnosis within the follow-up period (DSM-IV criteria). We performed competing risk regression models to obtain sub-hazard ratio (SHR) for each exposure, with death as competing risk. The exposures associated with dementia were included in a multivariable model to estimate their independent influence on dementia and the corresponding population attributable fraction (PAF). Results: Within the study period (mean follow-up, 82.3 months), 111 participants developed dementia (10.1%). In the multivariable model, APOE ε4 (SHR = 1.89, 95% CI 1.22-2.92, p = 0.005), diabetes (SHR = 1.56, 95% CI 1.00-2.39, p = 0.043), heart disease (SHR = 1.56, 95% CI 1.03-2.36, p = 0.037), stroke (SHR = 2.31, 95% CI 1.35-3.95, p = 0.002), and delirium (SHR = 8.70, 95% CI 3.26-23.24, p < 0.001) were independently associated with increased dementia risk. In the present cohort, around 40% of dementia cases could be attributable to preventable comorbid diseases.

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Section: Discussionmentioning

confidence: 99%

Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study

et al. 2020

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“…It is likely that this definition primarily captures hyperactive delirium, as this is more likely to be identified and documented by physicians and nurses. 37 , 38 , 42 Obviously the degree to which this diagnosis is made varies by center, so we mitigated this limitation by clustering our regression analyses by hospital. The incidence of postoperative delirium in our cohort (approximately 11%) is consistent with previous reports, including the National Institute for Health and Care Excellence guidelines, on the incidence of delirium diagnoses by physicians after hip fracture surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This diagnosis can be challenging to establish with hyperactive cases being more easily diagnosed. 37 , 38 As such, there is a high level of ascertainment bias and potential for considerable variation between hospitals. 39 , 40 The occurrence of postoperative delirium was identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for delirium, which have been shown to be highly specific but only weakly sensitive (specificity: 98%, sensitivity: 35%, positive predictive value: 100%).…”

Section: Methodsmentioning

confidence: 99%

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

et al. 2019

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Key Points Question Is surgery duration associated with postoperative delirium in patients receiving hip fracture repair? Findings In this population-based cohort study of 68 131 adults, increasing surgery duration was associated with a higher risk-adjusted likelihood of postoperative delirium (6% increase in delirium risk per additional half hour of surgery). This risk was higher in patients who received a general anesthetic. Meaning The findings suggest that prolonged surgery is associated with increased postoperative delirium, particularly when the patient has received a general anesthetic.

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“…Alternative methods to detect cognitive impairment and delirium in hip fracture patients could be the Abbreviated Mental Test (AMT) and the 4 ‘A’s Test (4AT) [31–33]. AMT and 4AT can be performed by nurses after brief training [34] . These tests are recommended in the recently published Norwegian interdisciplinary guidelines on hip fracture care [35].…”

Section: Discussionmentioning

confidence: 99%

Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture

Kristoffersen

Dybvik

Steihaug

et al. 2019

BMC Musculoskelet Disord

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Background About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons’ ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment. Methods The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? “Yes”, “Uncertain” or “No” by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared. Results Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function. Conclusion The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.

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Recognition of Delirium Features in Clinical Practice: Data from the “Delirium Day 2015” National Survey

Cited by 20 publications

References 30 publications

Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study

Estimating the potential for dementia prevention through modifiable risk factors elimination in the real-world setting: a population-based study

Association of Duration of Surgery With Postoperative Delirium Among Patients Receiving Hip Fracture Repair

Validation of orthopaedic surgeons’ assessment of cognitive function in patients with acute hip fracture

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